失代偿患者乙肝病毒相关性肝硬化长期抗病毒治疗效果

StephenW

Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus–related cirrhosis

    Jeong Won Jang1,9, Jong Young Choi1,9,*, Young Seok Kim2,9, Hyun Young Woo3,9, Sung Kyu Choi4,9, Chang Hyeong Lee5,9, Tae Yeob Kim6,9, Joo Hyun Sohn6,9, Won Young Tak7,9 andKwang-Hyub Han8,9
    1    Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
    2    Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
    3    Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
    4    Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
    5    Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
    6    Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
    7    Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
    8    Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
    9    Liver Cirrhosis Clinical Research Center, Seoul, Korea

*Address reprint requests to: Jong Young Choi, M.D., Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea. E-mail: [email protected]; fax: +82-2-3481-4025.

Article first published online: 18 MAR 2015

DOI: 10.1002/hep.27723

© 2015 by the American Association for the Study of Liver Diseases

Issue

Hepatology

Volume 61, Issue 6, pages 1809–1820, June 2015
Article has an altmetric score of 6



    Potential conflict of interest: Y.S.K. has served as an advisory committee member for Gilead. He served as a member for study sponsored by Bristol-Myers Squibb (BMS), Gilead, Roche, and MSD. W.Y.T. has served as a consultant and speaker for BMS, Gilead, and Roche. J.Y.C. has served as an advisory committee member or a member for a study sponsored by GSK, BMS, and Roche. J.W.J. has served as a consultant and speaker for BMS, Gilead, and Roche.

    This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020). The statistical consultation was supported by the Catholic Research Coordinating Center of the Korea Health 21 R&D Project (A070001), Ministry of Health & Welfare, Republic of Korea.


The effect of viral suppression on long-term disease outcome after decompensation in patients with hepatitis B virus (HBV)-related cirrhosis has not been established. The aim of this study was to determine the long-term effect of antiviral therapy (AVT) in patients with HBV-related decompensated cirrhosis. This was a multicenter, prospective, inception cohort study of 707 patients who presented with first-onset decompensated complications, including 284 untreated and 423 antiviral-treated patients (58 previously treated, 253 with early treatment, and 112 with delayed treatment). The primary endpoint was 5-year liver transplantation (LT)-free survival. Secondary endpoints included virological response (VR) and serological response and improvement in liver function. Despite baseline high HBV activity and worse liver function, antiviral-treated patients had significantly better transplant-free survival than untreated patients (5-year survival rates of 59.7% vs. 46.0%, respectively), with more apparent benefits from antivirals in Child-Turcotte-Pugh class B/C and high-viremia groups. The rate of VR and hepatitis B e antigen seroconversion at 5 years in antiviral-treated patients was 14.2% and 49.1%, respectively. A significant improvement in liver function was observed in treated versus untreated patients, with 33.9% of treated patients delisted for LT. Patients with early treatment had better clinical outcomes than those with delayed treatment. Survival was dependent on antiviral response, being significantly better in responders than in nonresponders or untreated cases. The initial benefit of AVT was negated over time in nonresponders. Antiviral treatment and maintained VR remained independently predictive of survival. The study results were corroborated by propensity score-matching analysis. Conclusion: AVT significantly modifies the natural history of decompensated cirrhosis, improving liver function and increasing survival. The results underscore the importance of promptly administering potent antiviral drugs to patients under consideration for LT. (Hepatology 2015;61:1808–1820)

StephenW

在病程后失代偿患者乙肝病毒相关性肝硬化长期抗病毒治疗效果

    郑元Jang1,9，钟扬Choi1,9，*，杨锡Kim2,9，玄英Woo3,9，宋圭Choi4,9，张亨Lee5,9，泰Yeob Kim6,9，朱炫Sohn6,9，赢得青年Tak7,9 andKwang-Hyub Han8,9
    内科，韩国天主教大学，医学院，首尔，韩国1系
    内科，医学顺天乡大学学院，富川，韩国2部
    内科，釜山大学医院，釜山，韩国的3系
    内科，全南国立大学医学院，韩国光州的4部
    内科，医学学院大邱天主教大学，大邱，韩国5系
    内科，汉阳大学九里医院，九里，韩国的6部
    内科，庆北国立大学医院，大邱，韩国7系
    内科，医学延世大学，首尔，韩国8部
    9肝硬化临床研究中心，韩国首尔

*地址转载请：钟扬崔医师，肝病，内科，首尔圣母医院，医学院，韩国天主教大学，＃222半坡daero，瑞草区，首尔系科137- 701，韩国。电子信箱：[email protected];传真：+ 82-2-3481-4025。

文章首次在线发表：2015年3月18日

DOI：10.1002 / hep.27723

©2015年肝病研究的美国协会

问题

肝病

第61卷，第6期，页1809年至1820年，2015年6月
文章有altmetric比分6



    潜在的利益冲突：Y.S.K.曾担任顾问委员会成员吉利德。他曾担任研究施贵宝（BMS），Gilead公司，罗氏公司，和MSD赞助的成员。 W.Y.T.曾担任顾问和扬声器BMS，Gilead公司和罗氏公司。 J.Y.C.曾担任咨询委员会成员或由葛兰素史克，拜耳，罗氏和赞助的一项研究成员。 J.W.J.曾担任顾问和扬声器BMS，Gilead公司和罗氏公司。

    这项研究是由赠款韩国医疗技术研发项目，卫生部和福利，大韩民国（HI10C2020）的支持。统计咨询由韩国保健21 R的天主教研究协调中心＆D项目（A070001），卫生部和福利，韩国的支持。


（HBV）相关的肝硬化尚未确定病毒抑制长期疾病的结果失代偿患者乙型肝炎病毒后的效果。这项研究的目的是确定患者HBV相关失代偿期肝硬化的抗病毒治疗（AVT）的长期效果。这是一个多中心，前瞻性，成​​立队列的707例患者的研究谁提出与首发失代偿期并发症，包括284未处理和423抗病毒治疗的患者（58以前治疗，253与早期治疗，并与112延误治疗）。主要终点是5年肝移植（LT） - 免费的生存。次要终点包括肝功能病毒学应答（VR）和血清学反应和改进。尽管基线高HBV活性更糟的肝功能，抗病毒治疗的患者有显著更好的移植生存率比未经治疗的患者（中，分别为59.7％和46.0％，5年生存率），与抗病毒药物在儿童期更明显的好处特科特-Pugh分级B / C和高血症组。 VR和乙型肝炎e抗原血清学转换的5年抗病毒治疗的患者的比率分别为14.2％和49.1％。观察肝功能显著改善治疗与未经治疗的患者，有治疗的患者除名LT的33.9％。患者早期治疗有较好的临床效果比那些延误治疗。生存是依赖于抗病毒反应，是显著更好反应比无反应者中的或未经处理的案件。 AVT的初始好处是时间否定了在无应答。抗病毒治疗和维持VR保持独立预测生存。这项研究结果是由倾向得分匹配分析证实。结论：AVT显著修改失代偿性肝硬化的自然历史，改善肝功能，增加存活。研究结果强调了在考虑及时给予有效的抗病毒药物，以患者LT的重要性。 （2015年肝病; 61：1808年至1820年）